Asian Pacific Journal of Cancer Prevention

Asian Pacific Journal of Cancer Prevention (아시아태평양암예방학회)
권호 표지
DOI QR코드

DOI QR Code

Whole-liver Radiotherapy Concurrent with Chemotherapy as a Palliative Treatment for Colorectal Patients with Massive and Multiple Liver Metastases: a Retrospective Study

  • Yin, Hang (Department of Radiotherapy, the Cancer Hospital of Harbin Medical University) ;
  • Lu, Kai (The Hospital of Daqing Oilfield) ;
  • Qiao, Wen-Bo (Department of Radiotherapy, the Cancer Hospital of Harbin Medical University) ;
  • Zhang, Hai-Yang (Department of Radiotherapy, the Cancer Hospital of Harbin Medical University) ;
  • Sun, Di (Department of Radiotherapy, the Cancer Hospital of Harbin Medical University) ;
  • You, Qing-Shan (Department of Radiotherapy, the Cancer Hospital of Harbin Medical University)
  • Published : 2014.02.28
Download PDF
⟨ Previous Next ⟩

Abstract

The purpose of this study was to investigate whether whole-liver radiotherapy plus a tumor-boost dose with concurrent chemotherapy is beneficial for colorectal cancer patients with massive and multiple liver metastases. From January 2007 to December 2012, 19 patients who exhibited massive (with a longest diameter > 5 cm) and invasive liver metastases and multiple metastases were treated with radiotherapy and concurrent chemotherapy. The total radiation dose was 53.4 Gy (range 38.8 Gy-66.3 Gy). All of the patients received a continuous intravenous dose of 5 fluorouracil (5-FU) 225 mg/m2 concurrently with radiation. The median survival time was 19 months. The 1- and 2- year overall survival rates were 78.3% and 14.3%, respectively. Of all of the patients who presented with abdominal pain, 100% experienced a decrease in pain. Decreases in the rates of ascites and jaundice were confirmed by ultrasound and bilirubin levels. No cases of Grade 4 or 5 acute or late toxicity were recorded. There were only two cases of Grade 3 toxicity (elevated bilirubin). These data provide evidence that whole-liver radiotherapy plus a tumor-boost dose with concurrent chemotherapy is beneficial for colorectal cancer patients with massive and multiple liver metastases.

Keywords

References

  1. Ajlouni MI, Merrick HW, Skeel RT, Dobelbower RJ. (1990) Concomitant radiation therapy and constant infusion FUdR for unresectable hepatic metastases. Am J Clin Oncol, 13, 532-5. https://doi.org/10.1097/00000421-199012000-00017
  2. Borgelt BB, Gelber R, Brady LW, Griffin T, Hendrickson FR. (1981)The palliation of hepatic metastases: results of the Radiation Therapy Oncology Group pilot study. Int J Radiat Oncol Biol Phys, 7, 587-91. https://doi.org/10.1016/0360-3016(81)90370-9
  3. Bydder S, Spry NA, Christie DR, et al (2003). A prospective trial of short-fractionation radiotherapy for the palliation of liver metastases. Australas Radiol, 47, 284-8. https://doi.org/10.1046/j.1440-1673.2003.01177.x
  4. Ben-Josef E, Normolle D, Ensminger WD, et al (2005). Phase II trial of high-dose conformal radiation therapy with concurrent hepatic artery floxuridine for unresectable intrahepatic malignancies. J Clin Oncol, 23, 8739-47. https://doi.org/10.1200/JCO.2005.01.5354
  5. Ben-Josef E, Lawrence TS (2005). Radiotherapy for unresectable hepatic malignancies. Semin Radiat Oncol, 15, 273-8. https://doi.org/10.1016/j.semradonc.2005.04.006
  6. Chung KY, Kemeny N (2005). Regional and systemic chemotherapy for primary hepatobiliary cancers and for colorectal cancer metastatic to the liver. Semin Radiat Oncol, 15, 284-98. https://doi.org/10.1016/j.semradonc.2005.04.007
  7. Cunningham SC, Choti MA, Bellavance EC, Pawlik TM (2007). Palliation of hepatic tumors. Surg Oncol, 16, 277-91. https://doi.org/10.1016/j.suronc.2007.08.010
  8. Chong VH, Bakar S, Sia R, et al (2013). Colorectal cancer screening among government servants in Brunei Darussalam. Asian Pac J Cancer Prev, 14, 7657-61. https://doi.org/10.7314/APJCP.2013.14.12.7657
  9. Chiu J, Tang V, Leung R, et al (2013). Efficacy and tolerability of adjuvant oral capecitabine plus intravenous oxaliplatin (XELOX) in Asian patients with colorectal cancer: 4-year analysis. Asian Pac J Cancer Prev, 14, 6585-90. https://doi.org/10.7314/APJCP.2013.14.11.6585
  10. Dimri K, Pandey AK, Trehan R, Rai B, Kumar A (2013). Conventional radiotherapy with concurrent weekly cisplatin in locally advanced head and neck cancers of squamous cell origin - a single institution experience. Asian Pac J Cancer Prev, 14, 6883-8. https://doi.org/10.7314/APJCP.2013.14.11.6883
  11. Eccles CL, Bissonnette JP, Craig T, et al (2008). Treatment planning study to determine potential benefit of intensitymodulated radiotherapy versus conformal radiotherapy for unresectable hepatic malignancies. Int J Radiat Oncol Biol Phys, 72, 582-8. https://doi.org/10.1016/j.ijrobp.2008.06.1496
  12. Hoyer M, Swaminath A, Bydder S, et al (2012). Radiotherapy for liver metastases: a review of evidence. Int J Radiat Oncol Biol Phys, 82, 1047-57. https://doi.org/10.1016/j.ijrobp.2011.07.020
  13. Krishnan S, Lin EH, Gunn GB, et al (2006). Conformal radiotherapy of the dominant liver metastasis: a viable strategy for treatment of unresectable chemotherapy refractory colorectal cancer liver metastases. Am J Clin Oncol, 29, 562-7. https://doi.org/10.1097/01.coc.0000236210.41199.91
  14. Leibel SA, Pajak TF, Massullo V, et al (1987). A comparison of misonidazole sensitized radiation therapy to radiation therapy alone for the palliation of hepatic metastases: results of a Radiation Therapy Oncology Group randomized prospective trial. Int J Radiat Oncol Biol Phys, 13, 1057-64. https://doi.org/10.1016/0360-3016(87)90045-9
  15. Lochan R, White SA, Manas DM (2007). Liver resection for colorectal liver metastasis. Surg Oncol, 16, 33-45.
  16. Lee WS, Kim MJ, Yun SH, et al (2008). Risk factor stratification after simultaneous liver and colorectal resection for synchronous colorectal metastasis. Langenbecks Arch Surg, 393, 13-9.
  17. Lausch A, Sinclair K, Lock M, et al (2013). Determination and comparison of radiotherapy dose responses for hepatocellular carcinoma and metastatic colorectal liver tumours. Br J Radiol, 86, 20130147. https://doi.org/10.1259/bjr.20130147
  18. Mohiuddin M, Chen E, Ahmad N (1996). Combined liver radiation and chemotherapy for palliation of hepatic metastases from colorectal cancer. J Clin Oncol, 14, 722-8. https://doi.org/10.1200/JCO.1996.14.3.722
  19. Mornex F, Girard N, Beziat C, et al (2006). Feasibility and efficacy of high-dose three-dimensional-conformal radiotherapy in cirrhotic patients with small-size hepatocellular carcinoma non-eligible for curative therapies--mature results of the French Phase II RTF-1 trial. Int J Radiat Oncol Biol Phys, 66, 1152-8. https://doi.org/10.1016/j.ijrobp.2006.06.015
  20. Malik HZ, Gomez D, Wong V, et al (2007). Predictors of early disease recurrence following hepatic resection for colorectal cancer metastasis. Eur J Surg Oncol, 33, 1003-9. https://doi.org/10.1016/j.ejso.2007.01.005
  21. Mendez RA, Hoyer M (2012). Radiation therapy for liver metastases. Curr Opin Support Palliat Care, 6, 97-102. https://doi.org/10.1097/SPC.0b013e32834de6d8
  22. Nordlinger B, Rougier P (2002). Liver metastases from colorectal cancer: the turning point. J Clin Oncol, 20, 1442-5. https://doi.org/10.1200/JCO.2002.20.6.1442
  23. Pulitano C, Bodingbauer M, Aldrighetti L, et al (2011). Liver resection for colorectal metastases in presence of extrahepatic disease: results from an international multiinstitutional analysis. Ann Surg Oncol, 18, 1380-8. https://doi.org/10.1245/s10434-010-1459-4
  24. Russell AH, Clyde C, Wasserman TH, Turner SS, Rotman M (1993). Accelerated hyperfractionated hepatic irradiation in the management of patients with liver metastases: results of the RTOG dose escalating protocol. Int J Radiat Oncol Biol Phys, 27, 117-23.
  25. Robertson JM, Lawrence TS, Walker S (1995). The treatment of colorectal liver metastases with conformal radiation therapy and regional chemotherapy. Int J Radiat Oncol Biol Phys, 32, 445-50. https://doi.org/10.1016/0360-3016(94)00591-8
  26. Symon Z, Levi M, Ensminger WD, Smith DE, Lawrence TS (2001). Selective radioprotection of hepatocytes by systemic and portal vein infusions of amifostine in a rat liver tumor model. Int J Radiat Oncol Biol Phys, 50, 473-8. https://doi.org/10.1016/S0360-3016(01)01522-X
  27. Schefter TE, Kavanagh BD (2011). Radiation therapy for liver metastases. Semin Radiat Oncol, 21, 264-70. https://doi.org/10.1016/j.semradonc.2011.05.006
  28. Thirion P, Wolmark N, Haddad E, Buyse M, Piedbois P (1999). Survival impact of chemotherapy in patients with colorectal metastases confined to the liver: a re-analysis of 1458 non-operable patients randomised in 22 trials and 4 metaanalyses. Meta-Analysis Group in Cancer. Ann Oncol, 10, 1317-20. https://doi.org/10.1023/A:1008365511961
  29. Topkan E, Onal HC, Yavuz MN (2008). Managing liver metastases with conformal radiation therapy. J Support Oncol, 6, 9-13.
  30. Timmerman RD, Bizekis CS, Pass HI, et al (2009). Local surgical, ablative, and radiation treatment of metastases. CA Cancer J Clin, 59, 145-70. https://doi.org/10.3322/caac.20013
  31. Tree AC, Khoo VS, Eeles RA, et al (2013). Stereotactic body radiotherapy for oligometastases. Lancet Oncol, 14, 28-37. https://doi.org/10.1016/S1470-2045(12)70597-1
  32. van der Pool AE, Mendez RA, Wunderink W, et al (2010). Stereotactic body radiation therapy for colorectal liver metastases. Br J Surg, 97, 377-82. https://doi.org/10.1002/bjs.6895
  33. Wang X, Hershman DL, Abrams JA, et al (2007). Predictors of survival after hepatic resection among patients with colorectal liver metastasis. Br J Cancer, 97, 1606-12. https://doi.org/10.1038/sj.bjc.6604093
  34. Xiang L, Wang Y, Hu BQ, Wu JB, Xia YF (2013). Preliminary results of a phase i/ii study of simultaneous boost irradiation radiotherapy for locally advanced nasopharyngeal carcinoma. Asian Pac J Cancer Prev, 14, 7569-76. https://doi.org/10.7314/APJCP.2013.14.12.7569
  35. Yeo SG, Kim DY, Kim TH, et al (2010). Whole-liver radiotherapy for end-stage colorectal cancer patients with massive liver metastases and advanced hepatic dysfunction. Radiat Oncol, 5, 97. https://doi.org/10.1186/1748-717X-5-97
  36. Zeng ZC, Tang ZY, Fan J, et al (2004). A comparison of chemoembolization combination with and without radiotherapy for unresectable hepatocellular carcinoma. Cancer J, 10, 307-16. https://doi.org/10.1097/00130404-200409000-00008

Cited by

  1. Selective Radiotherapy after Distant Metastasis of Nasopharyngeal Carcinoma Treated with Dose-Dense Cisplatin plus Fluorouracil vol.16, pp.14, 2015, https://doi.org/10.7314/APJCP.2015.16.14.6011
  2. Whole Liver Palliative Radiotherapy for Patients with Massive Liver Metastases vol.16, pp.15, 2015, https://doi.org/10.7314/APJCP.2015.16.15.6381